A nurse is assisting with the care of a client who has partial-thickness and full-thickness burns to his upper torso and face. Which of the following actions should the nurse take to prevent infection?

Place new linen on the client's bed every other day.

Change gloves between sites when providing wound care to multiple wounds.

Change the dressing on infected wounds first.

Monitor vital signs every 4 hr.

Answer and Explanation

The Correct Answer is B

A. Place new linen on the client's bed every other day: While changing linen regularly is important for maintaining cleanliness and preventing infection, waiting every other day may not be sufficient for a client with burns, especially if there is wound drainage or soiling. Linens should be changed more frequently, ideally daily or as needed, to ensure cleanliness and prevent the spread of infection.

B. Change gloves between sites when providing wound care to multiple wounds: This is a correct action. Changing gloves between sites when providing wound care helps prevent the spread of infection from one wound to another. It reduces the risk of cross-contamination and helps maintain a sterile environment during wound care procedures.

C. Change the dressing on infected wounds first: This is incorrect. Dressings on infected wounds should be changed promptly to prevent the spread of infection. However, changing the dressing on infected wounds first may lead to contamination of other wound sites if proper precautions are not taken. It's important to follow proper infection control procedures, including changing gloves between wound sites and using aseptic technique.

D. Monitor vital signs every 4 hr: Monitoring vital signs is important for assessing the client's overall condition, but it is not directly related to preventing infection. Vital signs may indicate signs of infection, such as fever or increased heart rate, but they do not prevent infection on their own. Other measures, such as wound care and infection control practices, are more directly related to preventing infection in clients with burns.

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Correct Answer is C

Explanation

A. Gelatin: Gelatin is sometimes used as a stabilizer in vaccines, including some flu vaccines. Individuals with severe gelatin allergies may need to avoid vaccines containing gelatin. However, egg allergy is more common and directly relevant to the contraindication for flu vaccination.

B. Peanuts: Peanuts are not typically used in the production of flu vaccines. Peanut allergies are not a contraindication for flu vaccination unless the person also has an egg allergy or another contraindication.

C. Eggs: Flu vaccines are commonly produced using chicken eggs. Therefore, individuals with a severe egg allergy should avoid flu vaccines, as they may experience an allergic reaction. This is especially important for young children, as they may be more prone to severe allergic reactions.

D. Bee Venom: Bee venom is not an ingredient in flu vaccines. While it's essential to consider allergies to various substances when administering vaccines, bee venom allergy does not impact the safety of flu vaccination.

A. "I know this can be embarrassing. I have kids myself so I understand, and it doesn't bother me." B. "Children who are hospitalized often regress. The toileting skills will return when your child is feeling better." C. "I will discuss your child's loss of bladder control with the provider." D. "Why is she wetting the bed in the hospital? She must wet the bed at home."

Correct Answer is B

Explanation

A. "I know this can be embarrassing. I have kids myself so I understand, and it doesn't bother me."

This response acknowledges the child's feelings and reassures the parents that bedwetting is a common occurrence, especially during hospitalization. It also demonstrates empathy by sharing a personal experience. However, it may not address the parents' concerns about their child's bedwetting or provide information on how to manage it.

B. "Children who are hospitalized often regress. The toileting skills will return when your child is feeling better."

This response provides an explanation for the bedwetting incident, reassuring the parents that it is a common response to hospitalization and will likely resolve once the child feels better. It offers support and normalization of the behavior, which can help alleviate the parents' concerns.

C. "I will discuss your child's loss of bladder control with the provider."

This response indicates that the nurse will address the issue with the healthcare provider, which is appropriate if further evaluation or intervention is needed. However, it may not directly address the parents' concerns or provide immediate reassurance.

D. "Why is she wetting the bed in the hospital? She must wet the bed at home."

This response may come across as accusatory or judgmental, which can increase parental anxiety or guilt. It does not provide reassurance or support to the parents and does not address the child's immediate needs.

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